Salicylate (Done Nomogram) • Digoxin Immune Fab Dosing • Iron Toxicity & Deferoxamine
<40 mg/dL → Asymptomatic
40–60 mg/dL → Mild toxicity — supportive care
60–80 mg/dL → Moderate toxicity — aggressive treatment, urinary alkalinization
>80 mg/dL → Severe toxicity — consider hemodialysis
>100 mg/dL → Hemodialysis indicated
Note: If ingestion <6 hours ago, levels may still be rising.
Note: Done nomogram was developed at 6h — interpretation at other times requires clinical judgment.
Urinary alkalinization: NaHCO₃ infusion to target urine pH 7.5–8.0
Known Level (ng/mL) + Weight (kg):
Fab Vials = (Level × Weight) / 100 [round up]
Known Acute Ingestion Amount (mg):
Fab Vials = Amount_mg × 0.8 / 0.5 = Amount_mg × 1.6
Empiric (unknown amount):
Acute: 10 vials
Chronic: 5 vials
Each vial of DigiFab = 40 mg (neutralizes ~0.5 mg digoxin)
Toxicity thresholds:
>2 ng/mL → Toxic
>10 ng/mL → Life-threatening
Serum Iron Thresholds:
<350 mcg/dL → Non-toxic (without symptoms)
350–500 mcg/dL → Moderate toxicity
>500 mcg/dL → Severe toxicity
If Serum Iron > TIBC → Free iron present (high risk)
Deferoxamine (DFO):
Dose: 15 mg/kg/hr IV
Maximum: 6 g/day (= 6000 mg/day)
Max rate: 6000 mg ÷ 24 hr = 250 mg/hr
Use lower of: 15 mg/kg/hr or 250 mg/hr
Indications for DFO:
• Serum iron >500 mcg/dL
• Serum iron > TIBC (free iron present)
• Symptomatic toxicity (metabolic acidosis, hemodynamic instability)
• >350 mcg/dL with symptoms
Endpoint: “vin rosé” urine clears (pink/salmon color = iron-DFO complex excretion)
